Epidemiology of suicide in Israel: a nationwide population study

Suicide cases in developed and emerging countries: an analysis using wavelets

ABSTRACT Objective The aim of this study was to use a wavelet technique to determine whether the number of suicides is similar between developed and emerging countries. Methods Annual data were obtained from World Health Organization (WHO) reports from 1986 to 2015. Discrete nondecimated wavelet transform was used for the analysis, and the Daubechies wavelet function was applied with five-level decomposition. Regarding clustering, energy (variance) was used to analyze the clusters and visualize the clustering process. We constructed a dendrogram using the Mahalanobis distance. The number of groups was set using a specific function in the R program. Results The cluster analysis verified the formation of four groups as follows: Japan, the United States and Brazil were distinct and isolated groups, and other countries (Austria, Belgium, Chile, Israel, Mexico, Italy and the Netherlands) constituted a single group. Conclusion The methods utilized in this paper enabled a detailed verification of countries with similar behaviors despite very distinct socioeconomic, geographic and climate characteristics.

Personal and psychiatric characteristics among Druze soldiers attempting suicide during military service

BACKGROUND

A non-fatal suicide attempt is a strong predictor of suicide. This study aimed to examine personal characteristics and psychiatric diagnoses among Druze soldiers who attempted suicide during their military service.

METHOD

The research group (n = 180) included all Druze soldiers who had attempted suicide between the years 2008-2012 (This number encompassed 18.4% of all suicide attempts in the IDF during those years). Three control groups were examined: Jewish soldiers who had attempted suicide (n = 155), and two additional groups comprising Druze and Jewish combat soldiers who had not attempted suicide (n = 5,255 and n = 205,819, respectively).

RESULTS

While Druze soldiers were diagnosed with psychiatric conditions less frequently than their Jewish counterparts, the more prolonged time to diagnosis among Druze may account for increased severity at time of diagnosis, thus increasing the risk of suicide attempt. A multivariate analysis revealed that the odds of a suicide attempt among Druze soldiers were much higher than among Jewish soldiers (OR 20.53; p < .001). In addition, it was found that average and high socioeconomic levels, strong Hebrew language skills, and high intelligence levels were protective factors against attempted suicide (p < .001, R² = 0.217).

LIMITATIONS

The three control groups were samples, while the research group (Druze attempters) consisted of all instances of attempted suicide during the study period. Comparing only samples would have offered less statistical power; therefore, using all the records in the research group improved accuracy.

Reasons for Living and Coping with Suicidal Ideation among Adolescents in Malaysia

Introduction

The rate of suicide ideation everywhere continues to increase, and adolescents are therefore at risk of displaying suicidal behaviour. This study examined the protective role of the reasons for living and coping strategies in reducing suicidal ideation among young adolescents in Malaysia.

Methods

A cross-sectional survey was conducted among 176 adolescents aged between 13 and 19 years of age with the majority being Malay and Muslim. The Brief Reasons for Living for Adolescents (BRFL-A), Jalowiec Coping Scale and Suicide Ideation Scale were employed.

Results

The results showed that the reasons for living and palliative coping strategy correlated negatively with suicide ideation; although, further analysis using multiple regression revealed that family alliance and optimistic and palliative coping strategies were found to be significant reasons for living that protect adolescents from suicidal thoughts. Also, those adolescents who used emotive and evasive coping strategies had higher suicidal ideation.

Conclusion

Cultural and social values continue to play an important role in protecting adolescents in Malaysia from suicidal behaviour.

Religion and Suicide: New Findings

Suicide rates and risk and protective factors vary across religions. There has been a significant increase in research in the area of religion and suicide since the article, "Religion and Suicide," reviewed these issues in 2009. This current article provides an updated review of the research since the original article was published. PsycINFO, MEDLINE, SocINDEX, and CINAHL databases were searched for articles on religion and suicide published between 2008 and 2017. Epidemiological data on suicidality and risk and protective factors across religions are explored. Updated general practice guidelines are provided, and areas for future research are identified.

Searching the Internet for psychiatric disorders among Arab and Jewish Israelis: insights from a comprehensive infodemiological survey

Israel represents a complex and pluralistic society comprising two major ethno-national groups, Israeli Jews and Israeli Arabs, which differ in terms of religious and cultural values as well as social constructs. According to the so-called “diversification hypothesis”, within the framework of e-health and in the era of new information and communication technologies, seeking online health information could be a channel to increase health literacy, especially among disadvantaged groups. However, little is known concerning digital seeking behavior and, in particular, digital mental health literacy. This study was conducted in order to fill in this gap. Concerning raw figures, unadjusted for confounding variables (time, population size, Internet penetration index, disease rate), “depression” searched in Hebrew was characterized by 1.5 times higher search volumes, slightly declining throughout time, whereas relative search volumes (RSVs) related to “depression” searched in Arabic tended to increase over the years. Similar patterns could be detected for “phobia” (in Hebrew 1.4-fold higher than in Arabic) and for “anxiety” (with the searches performed in Hebrew 2.3 times higher than in Arabic). “Suicide” in Hebrew was searched 2.0-fold more than in Arabic (interestingly for both languages search volumes exhibited seasonal cyclic patterns). Eating disorders were searched more in Hebrew: 8.0-times more for “bulimia”, whilst “anorexia” was searched in Hebrew only. When adjusting for confounding variables, association between digital seeking behavior and ethnicity remained statistically significant (p-value < 0.0001) for all psychiatric disorders considered in the current investigation, except for “bulimia” (p = 0.989). More in details, Israeli Arabs searched for mental health disorders less than Jews, apart from “depression”. Arab and Jewish Israelis, besides differing in terms of language, religion, social and cultural values, have different patterns of usage of healthcare services and provisions, as well as e-healthcare services concerning mental health. Policy- and decision-makers should be aware of this and make their best efforts to promote digital health literacy among the Arab population in Israel.

The Association Between Gender, Ethnicity, and Suicidality Among Vocational Students in Israel

Gender and ethnicity are significant factors when evaluating suicidal risk, especially among ethnically diverse populations. In the current study we explored the association between gender, ethnicity, and suicide ideation and attempts among Arab and Jewish vocational education and training high school students in Israel. Students (N = 3,554) completed a self-report survey evaluating suicide ideation and attempts, depression, anxiety, somatization, and sense of belonging. Hierarchical generalized linear modeling indicated that female Arab adolescents had elevated levels of suicide ideation, higher rates of suicide attempts, and greater psychological distress than Arab males and Jewish students. Furthermore, female Arab adolescents were found to be more susceptible to suicide ideation when depression levels were high. These results are discussed in the context of the double-jeopardy Arab young women face, as members of a minority ethnic group in Israel and their status as women within the patriarchal Arab culture.

Completed suicide and suicide attempts in the Arab population in Israel

Completed suicide and suicide attempts among four Arab groups defined by religious affiliation in Israel: Bedouins, Muslims (other than Bedouin), Christians and Druze were investigated using national databases of suicide (1999-2011), and suicide attempts (2004-2012). Age specific and age-adjusted rates and ratio of suicides to suicidal behavior were calculated, and compared with the total Israeli population rates. Age-adjusted suicide rates were lowest among the non-Bedouin Muslims, 2.5, followed in ascending order by Bedouins, 3.2, and Christian Arabs, 3.3 per 100,000 population, respectively. The highest rate was found among the Druze, 8.7, per 100,000 population, particularly for young males. The rates among the Arab groups were lower than for the total Israeli population, 7.9 per 100,000 population, except for the Druze. The pattern of suicide rates by gender, higher for males than females, was similar in all groups. The rates among the Arab Israelis were highest for the 15-24 year old age group, while in the total population the rates increased with age. Age-adjusted suicide attempt rates were higher amongst non-Bedouin Muslims, 84.8 per 100,000 population, followed by the Bedouin, 72.4; Druze. 64.9; and lowest among Christian Arabs, 58.6, all per 100,000 population. In the total Israeli population, the rate was even higher, 89.8 per 100,000 population. Suicide attempt rates were higher for women in all groups, except among the Druze. Rates were higher in most groups for ages 15-24. In this age group, the rates for female Muslims and Bedouins and for male Druze were higher than among the total population. Arab elderly had low rates of both suicide and suicide attempts. The ratio of suicides to suicide attempts increased with age for all groups, except for the Christian Arabs. It was markedly higher for the Druze, compared to 7.3 % for the total population for ages 15 and over. Findings highlight the importance of investigating the differential distribution of suicidal behavior by specific ethno-religious groups.

Genocide Exposure and Subsequent Suicide Risk: A Population-Based Study

The association between periods of genocide-related exposures and suicide risk remains unknown. Our study tests that association using a national population-based study design. The source population comprised of all persons born during1922-1945 in Nazi-occupied or dominated European nations, that immigrated to Israel by 1965, were identified in the Population Register (N = 220,665), and followed up for suicide to 2014, totaling 16,953,602 person-years. The population was disaggregated to compare a trauma gradient among groups that immigrated before (indirect, n = 20,612, 9%); during (partial direct, n = 17,037, 8%); or after (full direct, n = 183,016, 83%) exposure to the Nazi era. Also, the direct exposure groups were examined regarding pre- or post-natal exposure periods. Cox regression models were used to compute Hazard Ratios (HR) of suicide risk to compare the exposure groups, adjusting for confounding by gender, residential SES and history of psychiatric hospitalization. In the total population, only the partial direct exposure subgroup was at greater risk compared to the indirect exposure group (HR = 1.73, 95% CI, 1.10, 2.73; P < .05). That effect replicated in six sensitivity analyses. In addition, sensitivity analyses showed that exposure at ages 13 plus among females, and follow-up by years since immigration were associated with a greater risk; whereas in utero exposure among persons with no psychiatric hospitalization and early postnatal exposure among males were at a reduced risk. Tentative mechanisms impute biopsychosocial vulnerability and natural selection during early critical periods among males, and feelings of guilt and entrapment or defeat among females.

Risk of completed suicide in 89,049 young males assessed by a mental health professional

In an individual who seeks help or is referred to a mental health professional it is common sense and clinical practice to assume that suicidal thoughts and previous attempts constitute risk factors for imminent suicide. However, this assumption has not been supported by large, population-based longitudinal studies. The current study investigated whether reports of current suicidal ideation and a history of suicide attempts indeed increase risk for later completed suicide in a historical prospective study design. Sequential records on 89,049 young males assessed by mental health professionals were screened for suicidal ideation and a history of suicide attempts. The data were linked with death records from the Israeli Central Bureau of Statistics. Over a follow-up period ranging from 2 months to 9.8 years, 54 individuals died by suicide, constituting an average suicide rate of 6.48 per 100,000 person-years. Overall, neither reporting current suicidal ideation (without a history of suicide attempts; HR=1.29, 95% CI=0.57-2.90) nor reporting a history of suicide attempts (with or without current suicidal ideation; HR=1.67, 95% CI=0.71-3.97) were significantly associated with increased risk for later completed suicide. However, young males with a previously diagnosed psychiatric disorder who reported current suicidal ideation (HR=4.52, 95% CI=1.08-18.91) or a history of suicide attempts (HR=6.43, 95% CI=1.54-26.90) were at increased risk of death by suicide. These findings indicate that in this particular population reports of current suicidal ideation or of a history of suicide attempts are helpful in predicting future suicide only among those with a previous diagnosis of a psychiatric disorder.

Suicide and religion

Much of the evidence that religion provides a protective factor against completed suicide comes from cross-sectional studies. This issue of the Journal includes a report of a new prospective study. An understanding of the relationship between spirituality, religion and suicide is important in assessing and caring for those at risk.

[Autism spectrum disorder and suicidality]

INTRODUCTION

Most studies on suicide exclude subjects with autism spectrum disorders, yet there is a risk group. The purpose of this article is to present the data in the literature regarding the clinical and epidemiological characteristics of suicidality in subjects with autism spectrum disorders and to identify the factors that promote the transition to action.

METHODS

This review was carried out using the data set collected in Medline PubMed, items with "autism spectrum disorder", "pervasive developmental disorder", "Asperger's syndrome", "suicide", "suicide attempt", and "suicide behavior".

RESULTS

In all subjects from our research on PubMed, 21.3% of subjects with autism spectrum disorder reported suicidal ideation, have attempted suicide or died by suicide (115 out of 539 subjects) and 7.7% of subjects supported for suicidal thoughts or attempted suicide exhibited an autism spectrum disorder (62 out of 806 subjects), all ages combined. Suicidal ideation and morbid preoccupation are particularly common in adolescents and young adults. Suicide attempts are accompanied by a willingness for death and can lead to suicide. They are more common in high-functioning autism and Asperger subjects. The methods used are often violent and potentially lethal or fatal in two cases published. Suicide risk depends on many factors that highlight the vulnerability of these subjects, following autistic and developmental symptoms. Vulnerability complicating the diagnosis of comorbid depressive and anxiety disorders are major factors associated with suicidality. Vulnerability but also directly related to suicidality, since the origin of physical and sexual abuse and victimization by peers assigning them the role of "scapegoat" are both responsible for acting out.

CONCLUSION

Given the diversity of factors involved in the risk of suicide in this population, this does not validate "a" program of intervention, but the intervention of "customized programs". Their implementation should be as early as possible in order to treat while the brain has the greatest plasticity. The aim is to provide the necessary access to the greatest possible autonomy. Hence, including working communication skills and interaction, these subject will have independent means of protection, an essential complement to measures to protect vulnerable subjects; the vulnerability of direct and indirect suicidality. Comorbid diagnoses must take into account the specificities of these patients, their difficulties in communicating their mental state, and adapted and innovative therapeutic strategies must be offered and validated.

Religiosity is a protective factor against self-injurious thoughts and behaviors in Jewish adolescents: findings from a nationally representative survey

PURPOSE

Few studies have investigated the association between religiosity and self-injurious thoughts and behaviors specifically in adolescents, yielding inconsistent results. To date, no study has examined this relationship in a Jewish adolescent cohort.

METHODS

Self-injurious thoughts and behaviors, as well as depression, were assessed in a nationally representative sample of Jewish adolescents (n=620) and their mothers, using the Development and Well-Being Assessment Inventory (DAWBA) structured interview. Degree of religiosity was obtained by a self-report measure.

RESULTS

Using multivariate analysis, level of religiosity was inversely associated with self-injurious thoughts and behaviors (Wald χ(2)=3.95, P=0.047), decreasing the likelihood of occurrence by 55% (OR=0.45, 95% CI 0.2-0.99), after adjusting for depression and socio-demographic factors. This model (adjusted R(2)=0.164; likelihood ratio χ(2)=7.59; df=1; P<0.047) was able to correctly classify 95.6% of the patients as belonging either to the high or low risk groups.

CONCLUSION

This is the first study demonstrating religiosity to have a direct independent protective effect against self-injurious thoughts and behaviors in Jewish adolescents. This finding has clinical implications regarding risk assessment and suicide prevention. Further research can potentially elucidate the complex relationship between religiosity, self-injury and suicide in this population.

Suicide in young men

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.

Religion and suicide

Religion impacts suicidality. One's degree of religiosity can potentially serve as a protective factor against suicidal behavior. To accurately assess risk of suicide, it is imperative to understand the role of religion in suicidality. PsycINFO and MEDLINE databases were searched for published articles on religion and suicide between 1980 and 2008. Epidemiological data on suicidality across four religions, and the influence of religion on suicidality are presented. Practice guidelines are presented for incorporating religiosity into suicide risk assessment. Suicide rates and risk and protective factors for suicide vary across religions. It is essential to assess for degree of religious commitment and involvement to accurately identify suicide risk.

Peer Victimization in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Link to Depressive Symptomatology, Anxiety Symptomatology and Suicidal Ideation

The present exploratory study examined the level of peer victimization, depressive symptomatology, anxiety symptomatology, and level of suicidal ideation among adolescents and young adults diagnosed with Asperger's Syndrome (AS). This cross-sectional study used a self-administrated mail questionnaire and a Web-based questionnaire. The study included two samples. The first sample used snowball sampling, beginning with parents of adolescents and young adults diagnosed with AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who accessed Web sites for parents and individuals diagnosed with Autism Spectrum Disorder. A total sample of 10 adolescents and young adults diagnosed with AS was obtained. The high proportion of respondents with scores above the cutoff point on the overt victimization and relational victimization scales suggests that these adolescents and young adults experienced high levels of victimization. Of the sample, 20 percent met criteria for a diagnosis of Major Depressive Disorder, 30 percent met criteria for Generalized Anxiety Disorder and 50 percent had clinically significant level of suicidal ideation.

Facts and Myths about Suicide: A Study of Jewish and Arab Students in Israel

This research investigates the knowledge and myths regarding suicide among students in Israel, and examines whether they are affected by ethnic origin, gender, and religiosity. A random sample of 450 undergraduate students from two colleges was asked to fill out the Suicide Opinion Questionnaire (SOQ). Knowledge was measured by five SOQ items (α = 0.57) and myths of suicide by 20 SOQ items (α = 0.67). The level of Israeli students' knowledge about suicide is generally good ( X̅ X = 3.21; SD = 0.58). There are significant differences, however, between the Jewish ( n = 266) and Arab ( n = 154) students in knowledge about basic facts of suicide in Israel [( X̅ XArabs = 3.04; X̅ XJews = 3.32; t (419 0.95) = 4.63, p < .001)]. Although both groups share the same educational milieu, the Arab students tend more to believe that suicide rates are higher in Israel, and even more so among people of Asian African origin and minorities. They also perceive suicide by shooting to be the most popular suicide method. There are also significant differences between those groups with respect to their belief in suicide myths [( X̅Arabs = 2.91; SD = 0.40; X̅Jews = 3.17, SD = 0.41; t (419, 0.95) = 6.31, p < 0.01)]. Arabs tend more to relate suicide to lower religious affiliation, mental illness and chronic tendency, and to believe that the victim's relatives know nothing about the coming suicide. No significant differences were found based on religiosity or gender. Discussion focuses on the influence of the different cultural characteristics of lifestyle and the social control systems among Jews and Arabs in Israel on perceptions toward suicide.

Suicide in Ethiopian immigrants in Israel: a case for study of the genetic-environmental relation in suicide

Immigration is a major life stress event, which has been associated with increased levels of mental health problems. The linkage between immigration and suicide has been studied in various societies, with conflicting results. Extremely high rates of suicide have been found repeatedly among the population of the Ethiopian immigrants in Israel. These rates were significantly higher than other immigrant populations in the country. Possible explanations for this disparity are discussed, and future directions for further study of this area are suggested.

General characteristics of hospitalized patients after deliberate self-poisoning and risk factors for intensive care admission

BACKGROUND

Deliberate self-poisoning (DSP) is recognized as a major health problem worldwide with significant morbidity. After DSP, a substantial number of patients require intensive care unit (ICU) care, but little is known about how these patients differ from patients admitted to a general medical ward.

METHODS

From January 2001 to December 2002, all adult patients admitted to Soroka University Hospital after DSP were identified by ICD-9 coded diagnoses. Demographic data, previous psychiatric illness, laboratory tests, medication used in the DSP, presenting syndromes, treatment, and time elapsed after ingestion until emergency department presentation were obtained retrospectively from the patients' charts.

RESULTS

Out of a total of 217 patients, 34 (15.7%) were admitted to the ICU. Their mean age was 35.9 years and 65.4% of the patients were female. In multivariate analysis, the risk factors for ICU admission were suicide attempt with an antihypertensive medication (OR=12.2, 95% CI 2.3-65.8), coma on presentation (OR=15.8, 95% CI 4.9-50.7), and arrival at the emergency department less than 2 h after ingestion as compared to arrival after 2 h (OR=8.4, 95% CI 2.6-26.7). Previous psychiatric disease had no impact on ICU admission, and a recurrent attempt was protective of ICU admission.

CONCLUSIONS

We have shown that ingestion of antihypertensive medication, coma upon presentation, and emergency department admission less than 2 h after ingestion are predictive of ICU admission after a deliberate overdose with medication. These variables may help emergency department physicians to identify high-risk patients more quickly and, thereby, to improve patient care.

Association between antidepressant prescribing and suicide in Israel

The effects of antidepressants on suicide are controversial; on the one hand they decrease the incidence of death by suicide, as reflected in epidemiological studies, and on the other hand, there are claims that they increase the risk of impulsivity and suicide. In 1998, primary care physicians in Israel were not allowed to prescribe selective serotonin reuptake inhibitors and in 1999 this prohibition was lifted. We thus evaluated the association between patterns of antidepressant prescribing and the rate of death by suicide in Israel in 1998 compared with that in 2002. Data regarding deaths by suicide were obtained from the Central Bureau of Statistics. Annual rates of antidepressant prescribing were computed from the Intercontinental Marketing Services database. The Intercontinental Marketing Services data covers three out of the four Health Maintenance Organizations in Israel, encompassing 46% of all citizens. Prescribing of all antidepressants increased 2.6-fold between 1998 and 2002. This increase was significantly more pronounced for the selective serotonin reuptake inhibitors. A shift in prescription practices was noted, with a 1.37-fold increase in prescribing by primary care physicians. While the concomitant decrease in overall national rates of completed suicide did not reach significance (17-14 per 100,000), the incidence decreased significantly in men aged 55-74 years (33-22 per 100,000; P=0.029). An overall reduction in suicides, which was significant only in elderly men, was noted in association with increased rates of antidepressant prescription. This study is limited in scope but adds a unique viewpoint related to the possible positive effect of increased antidepressant prescribing in primary care on suicide.

Suicide attempts in israel: age by gender analysis of a national emergency departments database

An analysis of all emergency department admissions in Israel classified as an attempted suicide in the years 1996-2002 was done to examine attempted suicide rates by age and gender with particular attention to adolescents and young adults. Gender differences in attempted suicide rates were significant only during adolescence and young adulthood, ages 13 to 26. The highest rate for females was 3 years earlier than the highest rate for males. The results lead to the conclusion that women do not attempt suicide more than men, except for 13-26 year olds.

Suicide mortality in Southern Italy: 1998-2002

The purpose of the study was to describe the deaths by suicides that occurred in an area of Southern Italy in the period 1998-2002. Data were obtained from death records, and population estimates for each year were provided by the National Institute of Statistics. A total of 367 suicides were retrieved. The number of suicides was stable for the 5 years recorded, with the highest value for 1998, ranging from 1.4% for ages 0 to 14 to 25.1% for ages 25 to 44 years. Age-specific rates of suicide showed that the highest rates were in those 75 to 84 years old. Rates are always higher in males, with a tendency to stability or decrease in all age groups in the years observed, except for males in the 45- to 64-year-old age range, in whom an increase from 5.71 to 7.28 was observed. The suicides increased proportionally with age, in those with the lowest level of education (53.3%) and among retirees (46.5%). Hanging/suffocation (44.1%) and jumping from high places (23.2%) were the most frequently used methods of suicide. Males had higher standardized suicide rates ranging from 5.4 per 100,000 in 1999 to 7.7 in 1998, whereas in females the range was 1.4 per 100,000 in 2001 to 2.4 in 1998. The study shows that suicide rates in Southern Italy are lower compared with national trends.

Changes in mental disorder distribution among suicide attempters in mid-west area of Kanagawa

To clarify changes in mental disorder distribution in suicide attempters, a comparison was made between the period when an economic recession started (1992, 1993) and the period when the recession became serious (2000). The subjects were 212 suicide attempters admitted to the Emergency Medical Center of Tokai University Hospital during a 2-year period between 1992 and 1993 (group A) and 255 suicide attempters admitted during a 1-year period between January and December 2000 (group B). Mental disorders were classified according to the International Classification of Diseases (10th revision; ICD-10). Distribution was compared between groups A and B and significant differences were observed in mental disorder distribution (P < 0.001). The percentages of subjects with depression, those with neurotic disorders, and those with other disorders were higher in group B than in group A. Conversely, the percentage of subjects with schizophrenia was lower in group B than in group A. Mental disorder distribution in suicide attempters significantly changed. However, it was not certain that this change was related to the economic recession and increased unemployment in Japan.

Suicidal deaths in childhood and adolescence

Suicide has been reported as the second or third most common cause of death in children and adolescents worldwide. In this study, cases of under the age of 19 years submitted to the Institute of Forensic Medicine, First Specialization Board between 1996 and 2000 as suicides by the Board were evaluated retrospectively. The cases included in this study were the cases bearing locally questionable components, so had been submitted to the evaluations by the Board in order to eradicate the doubts. A total of 43 cases were investigated regarding age, gender, cause of death, manner of death, place of death, time of death, and the risk factors. Of the 43 cases evaluated, 31 cases were female and 12 cases were male. The notable suicide method was found to be firearms. Although it was clear that that not all of the suicide cases in this age group had been submitted to the Institute of Forensic Medicine, the most striking result of this study, nevertheless, was that girls constituted the 72% of suicidal deaths in this age group.